COLUMBIA  LIBRARIES  OFFSITE 

HEALTH  SCIENCES  STANDARD 


RC126  .D51 


HX641 47932 

Asiatic  cholera 


RECAP 


DE  '^^rOLF 


ASIATIC   CHOLERA 


i 


\<i\2lo 


1)51 


Columbia  ^ni'otvsitp 

tntl)fCitpofI?oogorb 

Collese  of  ^tipsicians  anb  burgeons 


Xifararp 


Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 

Open  Knowledge  Commons 


http://www.archive.org/details/asiaticcholeraskOOdewo 


^c 


irj   iT^ 


NO  LONSEK  THE  PR©P£BTY  i^t 

THE  LIBRARY  OF  WN»N 
fHEOl-Oei&AL  »JE>#!NARY,   N,  X* 


ASIATIC  CHOLERA 


A    SKETCH    OF    ITS 


HISTORT,  NATIJEE, 


PRE)T:XTIYE  MAXAGE3IEXT. 


OSCAR  C.  DeWOLF,  A.  M..  M.  D., 

Commissioner  of  Health,  Chicago; 

Professor  of  State  Medicnie,   Chicago  Medical   College  I    Member  of  the  Atnerican  Public- 

Hea.'ih  Association,  Etc  ,  Etc. 


[Copyright,  1SS5,  by  The  American  Book  Co.] 


CHICAGO: 
THE  AMERICAN  BOOK  COMPANY. 

133  and  133  Y/atasii  Avenue. 
1SS5. 


ASIATIC    CHOLERA. 


SKETCH  OF  ITS  HISTORY. 

The  following  short  summary  of  what  is  known  of  cholera 
is  derived,  for  the  most  part,  from  the  elaborate  researches  of 
John  Macpherson,  ]M.  D.,  of  London,  and  from  the  essays  of 
Drs.  McClellan,  Woodworth,  Peters,  Stille,  and  others. 

It  is  one  of  the  most  ancient  diseases  of  which  distinct  de- 
scriptions exist,  and  there  are  few  disorders  respecting  which 
such  an  uninterrupted  chani  of  evidence  has  been  preserved. 
Celsus  gives  a  clear  account  of  it,  A.  D.  7 ;  and  indeed  Hippo- 
crates, B.  C.  370,  speaks,  if  not  correctly,  still  with  fair  accuracy 
of  the  disease.  Galen,  A.  D.  131^  was  quite  aware  of  the 
gravity  and  antiquity  of  cholera,  and  gave  directions  upon  how 
to  prevent  relapses.  Almost  every  known  writer  in  medicine 
up  to  the  close  of  the  year  1500  has  described  a  disease  attended 
with  vomiting  and  purging  of  a  serous  character,  attended  by 
collapse  and  death  after  a  brief  interval,  or  a  protracted  conva- 
lescence and  fever;  but  the  communicable  and  migratory  nature 
of  the  disease  escaped  notice  or  record. 

When  the  Portuguese  discovered  a  practical  route  to  India 
by  the  way  of  the  Cape  of  Good  Hope,  the  more  civilized  na- 
tions of  Europe  were  placed  in  direct  communication  with 
Hindostan,  and  we  began  at  once  to  have  clear  records  of 
Asiatic  cholera. 

Tn  A.  D.  1500,  cholera  was  found  to  have  been  present  in 
every  place  in  the  west  coast  of  India  where  Europeans  had  an 
opportunity  of  observing  the  diseases  of  the  country. 

Sydenham,  Willis  and  Martin  speak  of  great  epidemics  of 
diarrhoeas,  accompanied  by  awful  twitchings  and  cramps,  as  pre- 
vailing annually  in  London   from   1666   to   1672.     In   the  year 


6  ASIATIC    CHOLERA 

immediately  preceding  the  great  fire  in  London,  when  the 
sanitary  condition  of  the  city  was  horrible,  tliis  "  plague  in  the 
guts"  caused  thousands  of  deaths. 

In  1837-8  a  severe  epidemic  raged  in  the  northwest  prov- 
inces of  India  and  suddenly  appeared  near  the  Caspian  Sea  in 
1839.  On  August  36,  1S39,  the  first  fatal  case  appeared  in 
Russian  territory,  in  the  town  of  Orenburg,  and  from  this  case  a 
•  fire  was  lighted  which  swept  over  Russia  in  1839-30,  reached 
England  in  1831,  and  the  United  States  in  1833.  .  If  there  was 
any  doubt  regarding  the  character  of  the  epidemics  noted  by 
Sydenham  and  Martin  in  England,  referred  to  above,  there  is  no 
question  about  the  case  reported  by  Dr.  Dixon  and  seen  by  him 
Aug.  5,  1 83 1,  at  Sunderland,  twelve  miles  below  New  Castle, 
for  here  was  a  recognized  case  of  malignant  cholera  as  we  un- 
derstand it  to-day,  appearing  in  an  epidemic  form  in  the  British 
Isles,  and  possibly  the  first.  The  sailors  returning  from  Riga 
and  St.  Petersburg  had  brought  home  their  chests  of  clothes, 
some  of  these  chests  belonging  to  comrades  who  had  died  in 
Russia,  and  which  had  not  been  opened  since  the  clothes  of  the 
deceased  had  been  placed  in  them. 

In  the  majority  of  the  published  accounts  of  the  cholera 
epidemic  of  1833  in  North  America,  the  arrival  of  the  ship  Car- 
ricks  at  the  Grosse  Isle  quarantine  station  on  the  St.  Lawrence, 
upon  the  3d  of  June,  has  been  taken  as  the  date  of  the  advent  of 
epidemic  cholera  upon  this  Continent.  It  is  probable,  however, 
that  the  Carricks  was  but  one  of  the  first  arrivals  of  infected 
vessels.  The  quarantine  records  show  that  on  the  38th  of  April 
the  ship  Constantia  from  Limerick  reached  Grosse  Isle  with  one 
hundred  and  seventy  emigrants,  among  whom  twenty-nine 
cholera  deaths  had  occurred  during  the  voyage;  that  on  the  14th 
of  May  the  ship  Robert  arrived  from  Cork,  having  had  ten 
deaths  on  board.  The  brig  Carricks  from  Dublin  anchored  off 
the  Isle  on  June  3d  with  emigrants,  among  whom  forty-five 
deaths  from  cholera  had  occurred.     Quebec  and  Montreal  were 


ASIATIC    CHOLERA.  ij 

thus  infected.  From  the  St.  Lawrence  the  epidemic  was  car- 
ried into  the  State  of  New  York.  On  June  13  an  emio-rant 
w^io  had  left  Montreal  on  the  Sth  died  of  cholera  at  Plattsburg. 
On  the  14th  another  died  at  Burlington,  and  on  the  15th  an 
emigrant  from  Montreal  died  at  White  Hall. 

On  the  evening  of  July  7,  General  Scott,  on  the  steamer 
S.  Thompson,  reached  Fort  ^Mackinaw  on  his  way  to  Chicao-o 
with  troops  from  Buffalo.  Four  of  the  enlisted  men  died  that 
evening  with  cholera.  On  the  loth  he  reached  Fort  Dearborn, 
and  on  the  night  of  his  arrival  at  Chicago  six  men  died.  Nearly 
every  State  in  the  Union  suffered  during  this  epidemic. 

In  1S34  cholera  again  appeared,  and  for  tlie  second  time  its 
advent  was  from  the  St.  Lawrence,  and  in  1S35  was  introduced 
from  Cuba.  After  these  visitations,  America  enjoyed  a  cholera 
immunity  of  nearly  thirteen  years.  In  1S4S,  however,  cholera 
had  advanced  in  Europe  to  its  ^vestern  shores,  and  on  the  2d  of 
December  of  that  year  it  appeared  at  the  ^Dort  of  New  Vork. 
The  epidemic  of  this  year  was  a  mild  one  throughout  the  United 
States. 

In  1854  the  first  appearance  of  cholera  in  this  country  was 
in  Chicago  among  recently  arrived  emigrants,  when,  from  the 
last  week  in  April  to  December  ist,  fourteen  hundred  and 
twenty -four  deaths  were  recorded.  From  the  large  cities  located 
upon  the  great  thoroughfares  the  disease  spread  Vv^dely  in  every 
direction. 

In  November,  1865,  cholera  was  brought  to  Ward's  Island, 
N.  Y.,  by  the  steamships  Atalanta  and  Herrman.  This  infec- 
tion had  come  out  from  India  by  way  of  the  Red  Sea  to  the 
Mediterranean,  and  by  steamer  and  sail  ^vas  carried  from  Bom- 
bay to  Ward's  Island  in  exactly  nine  months  bv  an  unbroken 
chain  of  connections.  It  w^as  an  atrociously  malignant  epidemic 
throughout  the  United  States. 

From  February  9  to  September  10,  1S73,  cholera  ap- 
peared   in    nineteen    States    of  the    L'nion,    appe:iring   at   New 


8  ASIATIC    CHOLERA. 

Orleans  on  the  first  date  mentioned.  It  was  undoubtedly  intro- 
duced by  emigrants  and  their  effects  from  the  infected  West 
Indies,  and  from  New  Orleans  was  distributed  to  the  interior  of 
the  Continent  by  water-transportation. 

NATURE  OF  THE  CHOLERA  POISON. 

Logic  as  well  as  science  is  very  positively  pointing  to  some 
form  of  germ-iife  as  the  causal  agent  in  propagating  cholera. 
This  germ  has  not  been  so  authoritatively  demonstrated  as  to 
receive  the  acceptance  of  the  medical  world,  but  there  is  no 
doubt  that  the  students  now  laboring  in  this  field  of  investigation 
will  be  able  to  show  us  the  "  physical  thing"  in  the  near  future. 
The  following  series  of  propositions,  condensed  from  a  vast  mass 
of  facts,  will  state  the  case  with  sufficient  clearness  for  the  pur- 
pose intended. 

I.  Malignant  cholera  is  caused  by  the  access  of  a  specific 
organic  poison  to  the  stomach  and  intestines;  which  poison  is 
developed  spontaneously  only  in  certain  parts  of  India. 

II.  This  poison  (outside  of  India)   is  contained   primarily 
'  in  the   ejections — vomit  and   stools — of  a  person  infected  with 

the  disease. 

III.  Favorable  conditions  for  the  growth  of  this  poison, 
when  nace  planted  outside  of  the  infected  body,  are  found  in 
ordinary  water  containing  organic  impurities,  and  in  decompos- 
ing- animal  and  veg-etable  matter. 

IV.  The  dangerous  properties  of  the  poison  may  be  pre- 
served for  an  indefinite  period  in  dried  cholera  ejections. 

V.  The  dried  particles  of  cholera  poison  may  be  carried  in 
clothing,  bedding,  books,  animal  skins,  etc.,  to  any  distance,  and 
when  liberated  mav  find  their  way  directly  into  the  stomach 
through  the  medium  of  water  or  food,  or,  meeting  the  necessary 
conditions  for  growth  and  development  outside  the  body  (see 
III),  it  may  reproduce  itself  to  a  limitless  extent. 

VI.  The  poison  may  be  destroyed  by  disinfectants  outside 
the  bodv. 


ASIATIC    CHOLERA.  Q 

VII.  It  is  not  probable  that  the  poison  in  cholera  dis- 
charges is  in  a  state  or  condition  to  become  immediately  active 
on  ejection  from  the  patient,  but  that  it  requires  a  further  devel- 
opment outside  the  body  to  become  infectious.  In  favoring  con- 
ditions of  heat  and  moisture  the  time  required  for  this  secondary 
development  is  short. 

VIII.  It  is  not  probable  that  the  cholera  poison  is  wafted 
about  in  the  atmosphere  except  to  a  very  lim.ited  extent;  but 
finds  its  way  from  sick  to  well  by  water  or  food,  except  in  cases 
of  very  close  contact,  as  the  washing  of  infected  clothing,  etc. 

The  deductions  which  may  legitimately  be  drawn  from  the 
foregoing,  are  of  general  applicability. 

The  importance  of  the  liberal  use  of  such  chemical  agents 
(disinfectants)  as  are  known  to  destrov  the  poison  in  discharges 
from  cholera  patients  is  apparent. 

In  proposition  VII  the  fact  of  the  general  immunity  from 
infection  of  ph3'sicians  and  nurses  who  treat  and  properlv  care 
for  cholera  patients,  is  explained.  It  should  be  generally  under- 
stood that  the  person  sick  from  cholera  can  not  communicate  his 
disease  to  attendants  if  the  discharges  are  properly  disinfected, 
and  if  no  soiled  clothing,  etc.,  be  permitted  to  remain  in  condi- 
tions favoring  the  secondary  development  of  the  poison. 

SYMPTOMS  AND  EARLY  TREATMENT. 

This  little  article  is  not  designed  as  a  "  ready  physician,'' 
and  has  no  advice  to  offer  concerning  the  treatment  of  cholera 
beyond  this:  That  the  most  able  assistance  within  reach  and 
means  of  the  sick  should  be  immediately  summoned.  It  seems 
proper,  however,  to  refer  to  the  importance  of  recognizing 
diarrhoea  during  epidemics  of  cholera  as  an  early  symptom  of 
the  disease,  and  to  the  simplest  means  of  checking  it  in  its  early 
stages. 

In  the  vast  majority  of  cases  in  the  milder  epidemics  the 
disease  is  ushered  in  by  a  passive,  painless  diarrhoea  from  one  to 


lO  ASIATIC    CHOLERA. 

five  days'  duration.  In  more  severe  forms  the  patient  in  appar- 
ent perfect  liealth  passes,  after  a  sing^le  dejection,  into  the  stage 
of  a  well-defined  cholera. 

The  active  treatment  of  the  premonitory  diarrhoea  is  of  the 
most  pressing  necessity  in  all  cases,  and  it  is  the  universal  expe- 
rience of  the  profession  that,  where  this  stage  of  the  disease 
is  properly  managed,  many  cases  of  cholera  are  averted.  The 
excreta  from  a  patient  suffering  from  this  premonitory  diarrhoea 
are  as  infectious  as  those  from  a  completely  developed  cholera 
patient,  and  should  be  subjected  to  the  same  disinfecting 
treatment. 

The  neglect  to  thus  treat  dejections  from  mild  and  perhaps 
traveling  cases,  which  may  finally  recover  unrecognized,  ex- 
plains the  transmission  of  the  disease  from  place  to  place  unde- 
tected. 

Whatever  else  the  person  sufTering  from  diarrhoea  in 
cholera  days  proposes  to  do,  he  should  at  once  place  himself  at 
rest.  Without  this  nothing  may  avail,  and  if  he  neglects  this, 
he  may  readily  pass  into  the  full-formed  disease.  Abstinence 
from  all  food,  or  at  least  except  that  of  the  blandest  quality — 
as  boiled  rice — is  desirable.  A  thick  poultice  of  flax-seed  meal 
or  Indian-corn  meal,  spiced  with  mustard  and  applied  to  the 
abdomen  hot  as  can  be  borne,  is  useful.  The  following  remedy 
I  know  to  be  helpful  in  the  conditions  above  referred  to: 

Take  of  Aromatic  Sulphuric  Acid,  i   ounce. 

Tincture  of  Opium,  S  scruples. 

Syrup  of  Ginger,  sufficient  to  make   4  ounces. 
Mix :  Take  i   teaspoonf ul  in  a  wine-glass  of  water  every  two  or  three 
hours  until  diarrhoea  is  checked. 

The  sulphuric  acid  fulfils  two  important  indications:  (i)  It 
is  a  marked  astringent,  and  (2)  it  is  well  known  that  the  cholera 
poison  thrives  in  alkaline  conditions,  within  and  without  the 
body,  and  is  retarded  in  its  development — perhaps  destroyed — 


ASIATIC    CHOLERA.  II 

by  acids.  Dilute  sulphuric  acid  is  a  perfectly  safe  and  efficient 
agent  with  which  to  modify  the  alkaline  secretions  of  the 
stomach  and  bowels. 

PREVENTION  OF  CHOLERA. 

Experience  teaches  that  the  safety  of  a  community  threat- 
ened with  an  outbreak  of  cholera  is  to  be  found  in  the  full 
recognition  of  the  importance  of  the  following  points: 

1.  Cleanliness  of  domicile  and  neighborhood — cleanliness 
in  everything — destroys  the  food  upon  which  the  cholera  poison 
thiives,  and  thus  limits  its  activity. 

2.  Attention  to  individual  habits  durinof  the  continuance 
of  the  epidemic. 

3.  Disinfection. 

4.  The  proper  care  of  the  sick. 

CLEANLINESS. 

The  attention  of  each  householder  should  be  directed  to 
the  condition  of  his  house  and  its  surrounding  premises.  Debris 
of  all  kinds  should  be  collected  in  a  pile  and  destroyed  by  fire. 
Outhouses,  as  privies,  stables,  etc.,  should  be  inspected,  cleaned, 
and  disinfected.  Dirty  and  damp  cellars  should  be  cleaned,  ven- 
tilated and  disinfected.  Wet  places  should  be  made  dry,  and 
sunlight  and   air  freely  admitted  everywhere. 

In  country  places  the  water  supply  should  be  rigidly  exam- 
ined. The  pollution  of  wells  by  drainage  from  privy  vaults 
into  ^vhich  cholera  dejecta  have  been  thrown  is  one  of  the  great 
sources  of  danger  where  wells  are  used;  and,  although  this 
water  may  be  of  the  most  deadly  character,  the  poison  may 
exist  in  such  form  as  to  render  it  impossible  to  detect  it  by  any 
means  known  to  science  to-day. 

If  wells  are  so  situated  that  the  possibility  of  impure  drain- 
age reaching  them  exists,  they  should  be  closed  in  such  manner 


12  ASIATIC    CHOLERA. 

as  will  absolutely  prevent  access  to  their  contents.  Roadside 
gutters  and  ponds  and  pools  of  stagnant  water  should  be  drained, 
cleaned  and  disinfected. 

The  general  cleanliness  of  the  house  and  surroundings,  or 
neighborhood,  having  been  secured,  there  remains  to  be  noted 

ATTENTION  TO  INDIVIDUAL  HABITS. 

While  I  would  not  advise  any  sudden  and  radical  change 
in  personal  habits  during  cholera  days,  yet  there  can  be  no 
objection  to  a  dirty  man  taking  a  bath;  on  the  contrary,  a  thor- 
ough soaping  of  the  body  and  a  hot  bath  daily  will  secure  the 
removal  of  what  may  and  often  does  prove  the  nucleus  of 
disease. 

The  surface  of  the  body  should  at  all  times,  both  of  the 
day  and  of  the  night,  be  fully  and  warmly  protected.  What- 
ever may  suddenly  check  perspiration  or  induce  a  chilliness  is 
dangerous,  and  should  be  avoided.  A  broad  flannel  bandage 
worn  snugly  around  the  person  over  the  abdomen  will  impart  a 
sense  of  comfort  and  a  relief  to  the  peculiar  feeling  in  the 
abdomen  so  universally  experienced  during  a  cholera  season. 

All  articles  of  food  known  to  be  indigestible,  or  not  to 
agree  with  the  individual,  should  be  avoided.  The  digestive 
apparatus  should  be  encouraged  to  the  performance  of  its  duty 
by  the  presence  of  good,  well-prepared,  wholesome  food.  Such 
ripe  fruits  and  well-cooked  vegetables  as  the  individual  habit- 
ually uses  may  be  continued  during  a  cholera  epidemic,  but  the 
use  of  unripe  fruit  and  badly-cooked  vegetables,  or  those  in 
which  the  process  of  vegetable  decomposition  has  commenced, 
is  dangerous.  In  cases  of  simple  diarrhoea  occurring  during  the 
continuance  of  the  epidemic,  all  fruits  and  vegetables  should  be 
avoided  until  the  digestive  track  has  recovered  its  tone  and 
function. 

Experience  has  shown  that  a  debauch  of  any  kind  predis- 
poses to  cholera  when  the  disease  is   epidemic;  but  if  the  indi- 


ASIATIC    CHOLERA.  12 

vidual  has  been  accustomed  to  the  use  of  wine,  brandy  or  malt 
Hquors,  they  may  be  continued  in  moderation. 

DISINFECTANTS. 

What  vaccination  is  to  small-pox,  hygienic  regulations  are, 
in  a  large  measure,  to  cholera.  The  rigid  observance  of  a 
sound  sanitary  condition  presents  to  this  virulent  disease  a  wall 
which  is  almost  insurmountable.  The  foundation  of  this  wall 
must  be  laid  in  disinfectants. 

A  disinfectant  is  an  agent  which  destroys  utterly  and  for 
all  time  the  disease  germ^  with  which  it  comes  in  contact.  It 
does  more;  it  renders  inert  the  products  of  decomposition  of 
vegetable  or  animal  matter  upon  which  disease  germs  thrive. 

A  deodorizer  may  or  may  not  be  a  disinfectant.  Dry 
earth  is  a  most  valuable  deodorizer,  but  it  is  not  a  disinfectant. 
Pasteur  found  the  germs  of  splenic  fever  virulently  active  about 
the  remains  of  a  bullock  dead  of  the  disease  and  buried  six  feet 
deep  for  ten  years.  It  should  not  be  forgotten  that  to  chancre 
or  remove  the  odor  from  putrescent  matter  may  have  no  influ- 
ence whatever  upon  disease  germs,  if  they  happen  to  be  present 
in  the  mass. 

The  agents  used  as  disinfectants  are  very  numerous,  while 
many  of  them  are  either  doubtful  in  their  efficiency,  or  known 
to  be  absolutely  worthless.  Only  those  which  are  reliable,  of 
easy  access,  and  which  may  be  popularly  used,  will  be  referred  to. 

All  wet  yards,  cellars,  etc.,  after  being  cleaned,  should  be 
treated  to  a  covering  of  fresh  unslaked  lime,  the  lumps  broken 
into  pieces  the  size  of  a  large  walnut.  Unslaked  lime  has  a 
caustic  property  by  which  it  destroys  organic  matter,  as  vvell  as 
a  powerful  affinity  for  water,  which  renders  it  a  valuable  drying 
agent. 

Woodwork  in  stables  and  cellars  should  have  a  coat  of 
whitewash,  into  each  pailful  of  which  two  ounces  of  sulphate  of 
copper  (first  dissolved  in  a  little  hot  water)  have  been  thrown. 


14  ASIATIC    CHOLERA. 

The  sulphate  of  iron  is  a  valuable  general  disinfectant, 
although  it  may  not  act  promptly  as  destructive  to  the  cholera 
poison.  Dr.  H.  C.  Wood  says  of  it:  "It  is  decomposed  by 
ammonia,  the  oxide  of  iron,  a  persistent,  powerful  ozonizing 
agent,  being  precipitated.  It  slowly  but  persistently  attacks 
organic  matter  about  it,  oxidizing  it,  and  being  reduced  to  a 
sulphide  of  iron." 

The  most  advantageous  use  which  can  be  made  of  this 
agent  is  as  follows:  Place  a  sound  barrel  in  upright  position, 
raised  two  or  three  feet  from  the  ground,  in  some  conyenient 
place  in  barn  or  outhouse,  and  insert  a  wooden  spigot  four  inches 
above  the  bottom  of  the  barrel.  Suspend  in  the  barrel  sixty 
pounds  of  sulphate  of  iron  in  a  coarse  gunny  sack,  and  fill  the 
barrel  with  soft  water.  This  solution  may  be  freely  used  in 
dirty  gutters,  or  thrown  into  privy  vaults  and  cesspools. 

If  a  privy  vault  is  foul  and  cannot  be  immediately  cleaned, 
it  should  be  treated  as  follows:  Mix  in  a  dry  and  covered  place 
two  parts  of  unslaked  lime  and  one  part  of  charcoal.  Throvv^ 
two  or  three  shovelfuls^  of  the  mass  upon  the  surface  of  an 
impure  privy  or  cesspool,  and  in  three  hours  add  a  pailful  of 
the  solution  of  sulphate  of  iron  before  mentioned.  A  large 
school  vault,  in  daily  use  by  a  large  number  of  persons,  has 
been  kept  in  perfect  condition  by  this  daily  treatment.  If  the 
vault  has  received  dejections  from  cholera  patients,  the  above 
treatment  is  not  sufHcient  to  insure  the  destruction  of  the  poison. 
In  such  cases  the  free  use  of  fresh  chloride  of  lime — twenty 
pounds  to  an  ordinary  vault — is  advisable. 

The  iron  solution  should  not  be  used  to  disinfect  fabrics,  as 
it  colors  them.  Such  articles  of  clothing,  bedding,  etc.,  as  can 
be  washed  should  first  be  treated  in  a  solution  of  sulphate  of 
zinc  prepared  as  follows: 

Sulphate  of  Zinc,  ly^  pounds. 

Common  Salt,  ^'  pound. 

Hot  Water,  6     gallons. 


ASIATIC    CHOLERA.  I5 

Soak  all  infected  clothinsr,  bedding,  etc.,  in  this  solution  for 
three   hours,  and  then  wash  in  boihng  \vater. 

The  contents  of  infected  beds,  as  feathers,  hair,  husks,  moss, 
excelsior,  etc.,  should  be  burned. 

All  rooms  in  which  persons  have  been  sick  with  cholera 
should  be  disinfected  bv  sulphurous  acid  gas.  Have  all  win- 
dows, fire-places,  key-holes,  doors,  and  other  openings  securely 
sealed  by  strips  of  paper  pasted  over  them.  Hang  on  lines  or 
racks  all  carpets  and  material  that  can  not  be  ^vashed.  Place 
an  iron  pot  on  two  bricks  or  stones  in  the  center  of  the  room  and 
throw  into  the  pot  some  live  (wood)  coals,  upon  ^vhich  place 
four  pounds  of  crushed  brimstone.  If  wood  coals  are  not  con- 
venient, saturate  the  brimstone  ^vith  alcohol  and  ignite.  This 
amount  will  suffice  for  a  room  twenty  feet  square.  The  room 
should  be  kept  tightly  closed  for  twenty-four  hours. 

Corrosive  sublimate  is  the  clieapest,  and  probably  the  most 
efficient  disinfectant  known  to  science  to-day.  The  only  serious 
objection  to  its  popular  use  is  its  great  activity  as  a  poison;  but 
this  fact  need  hardly  be  regarded  as  a  special  objection,  for  all 
disinfectants  are  more  or  less  actively  poisonous  when  accident- 
ally used.  Under  the  direction  of  the  sanitary  inspectors  of 
Chicago  there  were  used  during  many  of  the  days  of  the  past 
summer,  in  disinfecting  privy  vaults,  600  gallons  a  day  of  a 
solution  of  corrosive  sublimate.  It  is  soluble  in  sixteen  parts  of 
^vater,  but  this  strength  is  not  required  for  any  disinfecting  use. 
One  pound  of  corrosive  sublimate  dissolved  in  100  pounds  of 
w^ater,  and  the  solution  colored  with  enough  permanganate  of 
potassa  to  give  it  a  purple  tint,  so  that  it  can  readily  be  distin- 
guished from  water,  will  cost  less  than  one  dollar,  and  should 
always  be  kept  at  hand  near  patients  suffering  from  cholera.  It 
is  a  neat,  odorless  and  very  efficient  agent.  Its  proper  use  will 
be  referred  to  when  speaking  of  the  care  of  the  sick.  This  solu- 
tion should  not  be  kept  in  metal  receptacles. 

Chloride  of  lime  is  regarded  bv  some  authorities  as  the  best 
disinfectant  for  treating  the  dejections  of  cholera,  because  of  the 


l6  ASIATIC    CHOLERA. 

rapidity  of  its  action.  It  is  cheap,  and  if  it  be  perfectly  fresh,  con- 
taining 25  jDcr  cent,  of  available  chlorine,  and  is  used  insufficient 
quantity,  it  is  probably  efficient.  A  solution  may  be  made  by 
dissolving  eight  ounces  of  chloride  of  lime  in  one  gallon  of  soft 
water  and  keeping  it  in  a  close  vessel. 

The  popular  use  of  chloride  of  lime  by  placing  a  saucerful 
under  beds,  in  hallwaj^s,  under  stairs,  in  water  closets,  etc.,  with 
the  idea  that  it  has  a  disinfecting  influence,  used  in  this  manner, 
is  a  delusion.  No  apartment  occupied  by  human  beings  can  be 
disinfected,  because  disease  germs  are  not  destroyed  in  an  atmos- 
phere that  can  be  respired. 

CARE  OF  THE  SICK. 

It  is  the  universal  experience  of  sanitarians  that  the  mild 
and  undetected  cases  of  cholera  are  the  greatest  source  of  dan- 
ger to  a  community.  The  discharges  from  the  bowels  of  a 
patient  not  yet  confined  to  his  bed  are  deposited  wherever  he 
happens  to  be;  and,  swarming  as  they  are  with  cholera  germs, 
which  only  need  favoring  conditions  to  develop  a  ferocious  activ- 
ity, they  become  so  many  foci  of  infection  to  the  neighborhood. 

I  repeat  again,  that  the  individual  sufFermg  from  cholera 
can  not  communicate  the  disease  to  those  about  him;  but  his 
discharges — or  clothing,  etc.,  soiled  by  his  discharges — if  not  des- 
troyed will,  in  the  course  of  a  few  hours'  exposure  to  the  atmos- 
phere, become  a  virulent  source  of  infection  to  others.  The 
important  point,  therefore,  in  the  hygienic  treatmei..  of  cholera 
is  to  destroy  — and  destroy  absolutely — the  poison  in  the  dis- 
charges from  the  patient.  If  this  be  done,  physicians,  nurses,  and 
attendants  upon  the  sick  generally  escape  the  disease,  and  the 
community  is  protected. 

No  excreta  of  cholera  patients  should  be  emptied  into 
water-closets  or  privy  vaults,  or  even  permitted  to  leave  the 
bedside  of  the  patient  until  thoroughly  disinfected. 

After  each  vomit  or  dejection  one  pint  of  the  solution  of 
corrosive  sublimate  or  of  chloride  of  lime  should  be  thrown  into  the 


ASIATIC    CHOLERA. 


17 


vessel  and  intimately  mixed  with  the  discharge;  it  may  be  then 
carried  from  the  house,  and  the  vessel  which  contained  them 
should  be  carefully  washed  with  the  same  solution,  and  the  water 
used  for  that  purpose  permitted  to  remain  in  the  vessel  for  the 
next  discharge.  When  the  case  has  terminated,  the  floors,  car- 
pets, or  other  furniture  that  may  have  been  soiled,  should  be 
carefully  disinfected  by  burning  brimstone^as  pointed  out  above, 
and  the  mattress  or  bed  soiled  by  discharges  should  be  burned 
at  once.  All  sheets,  pillows,  napkins,  or  other  clothing  soiled 
by  discharges  should  be  immediately  thrown  into  the  solution 
of  zinc,  or  of  corrosive  sublimate,  and  never ^  under  any  circum- 
stances^ taken  from  the  room  taitil  thus  im^nersed.  Should  the 
case  terminate  fatally,  the  body  should  be  placed  in  the  casket 
upon  a  thick  layer  of  sawdust  ^t^Z'e/r^z'^^  with  corrosive  sublimate 
solution,  and  the  burial  should  not  be  delayed  beyond  the  time 
necessary  to  assure  the  attendants  that  death  has  occurred. 


Date 

Due 

OCT 

4  }997  0CT2  5iq^ 

' '  1' 

i 

i    _  >. 

•*^''M^ 

n.    c         r~'                    **^ 

,■     A 

..W  k 

^t^x.  ^ 

1 

'    1  ^M 

£* 

*^ 

i 

1 

1 

f 

RC126 


D51 


De  Wolf 


COLUMBIA  UNIVERSITY  LIBRARIES 


0043062490 


